The Chicago Tribune tested 255 pharmacies to see how often stores would dispense risky drug pairs without warning patients. Fifty-two percent of the tested pharmacies sold the medications without mentioning the potential interaction. (Chicago Tribune)

The Chicago Tribune tested 255 pharmacies to see how often stores would dispense risky drug pairs without warning patients. Fifty-two percent of the tested pharmacies sold the medications without mentioning the potential interaction. (Chicago Tribune)

Gov. Bruce Rauner has ordered state agencies to examine how to bolster accountability at drugstores and protect the public's health following a Tribune investigation that found pharmacists failed half of the time to warn about dangerous drug interactions.

The Republican governor's move came as the longtime Democratic chair of an Illinois House health-care committee began crafting legislation on Monday to set minimum staffing levels at pharmacies to prevent pharmacists from racing through prescriptions like an "assembly line."

The newspaper, in stories published online Thursday and in print Sunday, found that 52 percent of 255 pharmacies tested by reporters sold risky drug pairs without mentioning the potential for harmful or even fatal interactions.

"The Tribune's investigation revealed a troubling potential that some pharmacists are not complying with state law," Rauner's office said in a statement. "The governor has asked state agencies to investigate what additional action, if any, could be taken either administratively or through legislation to hold wrongdoers accountable and protect public health."

Drug interactions, in which one drug alters the effect of another, have been a major public health problem for years, but little progress has been made in reducing the risks.

Rep. Mary Flowers, D-Chicago, called for the minimum staffing levels as part of a multipronged bill she hopes will overhaul how pharmacies, the last line of defense for patients seeking safe medications, handle prescriptions.

The Tribune report "really opened my eyes, and I'm sure it has opened up a lot of people's eyes," she said.

Flowers, who chairs the Health Care Availability and Accessibility Committee, said she would seek in the new legislative session starting in January to have pharmacists file reports with the state when doctors prescribe medications that are risky when taken together, to require pharmacy computers to clearly define the most dangerous interactions, and to require doctors to tell patients when the medicine combination needs to be changed.

She also wants signs prominently posted at pharmacies that provide a state hotline number for patients to call if a pharmacist failed to catch a bad drug interaction or if a pharmacist fails to tell a patient about the potential for a major drug interaction. In addition, Flowers said she wants to study whether standards are strong enough for pharmacy technicians in Illinois.

Phil Velasquez / Chicago Tribune

Gov. Bruce Rauner on Monday asked state agencies to study ways to improve accountability at pharmacies following a Tribune investigation on local drugstores' high failure rate in advising their customers of bad drug combinations.

Gov. Bruce Rauner on Monday asked state agencies to study ways to improve accountability at pharmacies following a Tribune investigation on local drugstores' high failure rate in advising their customers of bad drug combinations. (Phil Velasquez / Chicago Tribune)

The Tribune testing represents the largest and most comprehensive study of its kind. In response to the findings, three of America's biggest pharmacy chains — CVS, Walgreens and Wal-Mart — said they would take steps to improve patient safety at stores nationwide. In the Tribune tests, CVS failed 63 percent of the time, Wal-Mart 43 percent of the time and Walgreens 30 percent of the time.

Flowers said in an interview that she feared the speed required for pharmacists to keep up with their workloads may cause "repercussions."

"Just like a person speeding up and down the highway, sooner or later there's going to be crash," she said. "They're moving way too fast."

In Illinois, pharmacists who detect a serious interaction are supposed to contact the prescribing doctor to see if the order is correct or if an alternative therapy is available, according to the Illinois Department of Financial and Professional Regulation. Pharmacists then should alert the patient.

But in the Tribune tests, many pharmacies dispensed dangerous drug pairs without verbally warning the tester or attempting to contact the doctor about the potential interaction.

Illinois law also requires pharmacies to conduct several drug safety checks on prescriptions, including whether the dose is reasonable and whether the medication might interact with other drugs the patient is taking. Yet the Tribune found that pharmacists rarely asked what other medications testers were using.

And though Illinois requires pharmacies to "offer to counsel" patients on all prescriptions, pharmacists throughout the industry often address this requirement by having technicians ask patients at checkout, "Do you have any questions for the pharmacist today?" or sometimes simply, "Any questions?" Some states require actual counseling, at least on a first-time medication.

Rep. Lou Lang, D-Skokie, said in an interview that he has met with union members who have expressed concerns about the number of hours pharmacists are often required to work and that they wanted to cut hours in order to minimize the chances of errors.

"We want to make sure that people that are filling prescriptions are well-rested and well-treated and not filling prescriptions at a time that they are doing so to the detriment of public safety," Lang said. "For instance, we don't allow pilots to fly more than a certain number of hours a day or a week because we want them well and alert because they are flying precious cargo — human beings — in those planes."

Despite the ongoing difficulties in state budget negotiations, Rauner said his administration would "look forward to working with members of the General Assembly on a bipartisan basis to explore all options" to see what can be done to prevent dangerous drug interactions.

Carmen Catizone, executive director of the National Association of Boards of Pharmacy, previously told the Tribune he would like to see all states require pharmacists to provide counseling about first-time medications and changes of doses. Catizone also said authorities should examine whether to set minimum staffing levels for pharmacies to address workload issues. Pharmacies sometimes have to fill hundreds of prescriptions a day.

The president and CEO of the Illinois Retail Merchants Association, Rob Karr, said the Tribune reporting "highlights a systemwide issue from prescriber to pharmacy."

"No one party carries a larger responsibility," said Karr, whose group represents retail, independent and grocery pharmacy chains throughout Illinois. "A knee-jerk reaction focused solely on pharmacy will miss the mark."